Illinois Takes Two Giant Steps on Family Health Care: Significant New Efforts on Family Insurance and Children's Primary Care

June was a month of accomplishments for the Blagojevich administration’s policy priority on health care. The administration took successful action on two important initiatives advocated by the Sargent Shriver National Center on Poverty Law and its allies to make substantial progress in reducing the numbers of uninsured and in improving the chances that children insured by Medicaid actually get quality preventive and primary care.

First, in the final budget that passed at the end of May, the General Assembly adopted the governor’s proposal to complete the implementation of the FamilyCare program. That step, effective January 1, 2006, will offer health care to approximately 100,000 more working families.

Second, on June 27, an agreement to settle a long-standing federal lawsuit was announced; the settlement is intended to expand access to quality medical care for children enrolled in Medicaid. The steps taken under the agreement are designed to increase the numbers of doctors and dentists serving these children and to increase the chances that these children will receive all the immunizations, developmental screenings, and other well-child services necessary for their good health and development and maximum life chances.

FamilyCare

The budget includes $5.75 million in state funds to fund fully the third and final year of FamilyCare’s three-year phase-in plan. The funds will leverage $11 million of federal funding. With this funding, the program’s eligibility ceiling will rise, effective January 1, 2006, from the current 133 percent of the federal poverty level ($25,000 for a family of four) to 185 percent ($35,000 a year for a family of four). This addition will increase the eligible target population for FamilyCare health insurance to about 400,000, although actual enrollment is expected to be significantly lower. Current enrollment in FamilyCare is about 100,000.

The newly eligible group will also qualify for the “premium subsidy choice.” This group will be able to choose either to be covered by the state’s insurance (Medicaid) or to receive a cash subsidy to help pay the premium to be covered by an employer’s health insurance or private insurance.

FamilyCare offers these health insurance options for parents or caretakers of minor children (the children are already covered under Medicaid or KidCare). The federal government pays 65 percent of the program costs.

This last year of the FamilyCare ramp-up completes the keeping of Governor Blagojevich’s promise made over two years ago to implement the program fully over that time period.

Children’s Primary and Preventive Care

The June 27 announcement of the improvements in children’s primary and preventive care came in the context of the Memisovski v. Maram lawsuit in federal district court in Chicago. It is embodied in a settlement agreement that resolves the case and addresses concerns first raised in 1992 that children covered by Medicaid in Cook County were not able to see doctors and receive recommended well-child services. In provisionally approving the settlement, the judge ordered that the affected families receive notice of the provisions of the settlement, and he set a hearing date in early November to hear any objections and to give the settlement final approval.

The agreement is designed to ensure that children from low-income families have access to regular, consistent physician care. The plan includes increases in pediatrician reimbursement rates to help attract and retain more doctors in the Medicaid program as well as bonus payments to doctors who successfully keep their young patients from missing important services and falling through the cracks. The rate increases and bonus payments, by approximately doubling what pediatricians are currently paid by Medicaid for well-child care, have the potential to attract more doctors to the program and ensure adequate access to care for the children. Dental providers will receive a major increase in reimbursement rates to the levels paid by the State employee dental plan. The State will also contract with a third-party vendor to provide a referral network for families to assist them in getting necessary care and services. The agreement has numerous other provisions as well.

The settlement comes after federal Judge Joan Humphrey Lefkow’s August 2004 decision that the Illinois Department of Public Aid and the Illinois Department of Human Services were violating the rights of Medicaid-eligible children in Cook County to receive health care under the Medicaid program. Specifically the court ruled that the State failed in its obligations to provide these children with access to medical care that is equal to the access to care received by privately insured children and the State failed to ensure that these children receive the preventive health services required by the federal Medicaid program known as Early and Periodic Screening, Diagnostic, and Treatment services (EPSDT).

The case was originally filed in 1992. Successive state administrations had fought the case for over a decade, and it was inherited by the Blagojevich administration. Instead of fighting the case further through the courts of appeals, the Blagojevich administration has decided that the improvement of children’s primary and preventive health care is a high priority, one that is fully consistent with a range of other initiatives to improve health care in Illinois. Good preventive care for children provides them with the best chances in life and over the long haul is a smart step to begin harnessing the exploding costs of the larger health care system.

The children are represented by the Shriver Center and by allied lawyers with Health & Disability Advocates and the Chicago law firm of Goldberg Kohn Bell Black Rosenbloom & Moritz Ltd. (working pro bono).